<%@ Page Language="C#" AutoEventWireup="true" CodeFile="frmClinical_PatientRecordCD4.aspx.cs" Inherits="frmClinical_PatientRecordCD4" %>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" >
<head>
 <title id = "lblHeader" runat = "server" >Lab Values</title>
 <link rel="stylesheet" type="text/css" href="../Style/styles.css"/>
 <link rel="stylesheet" type="text/css" href="../Style/calendar.css"/>
 <script language="javascript" type="text/javascript" src="../incl/weeklycalendar.js"></script>
<script language="javascript" type="text/javascript"  src="../incl/dateformat.js"></script>
<script language="javascript" type="text/javascript" src="../incl/jsDate.js"></script>
<script language="javascript" type="text/javascript">buildWeeklyCalendar(1);</script>
</head>
 
<body>
  <form id="CTC" method="post"  runat="server">


    <div class="border center formbg" style="width:696px; height:204px; padding-left:5px; padding-right: 5px; padding-top:5px; padding-bottom:5px">
       <table class ="left" border="0">
         <tbody>
          <tr>
             <td class ="border pad5 whitebg" align="left">
               <div id="divCD4" runat="server">
                <label style="margin-left:31px">CD4:</label>
                <asp:TextBox ID ="txtCD4" runat ="server"> </asp:TextBox> 
                <label>c/mm^3</label>
               </div>
             </td>
             
             <td class ="border pad5 whitebg" style="width: 337px">
                <div id="divCD4Percent" runat="server">
                    <asp:TextBox ID ="txtCD4Percent" runat ="server"> </asp:TextBox>
                    <label>Percent</label>
                </div>
             </td>        
          </tr>
          <tr >
            <td class ="border pad5 whitebg" align="center">
                <div id="divTLC" runat="server">
                  <label class="left">TLC:</label>
                  <asp:TextBox ID ="txtTLC" runat ="server"> </asp:TextBox>               
                  <label>10^3 cells/mcl</label>
                </div>
            </td>
            <td class ="border pad5 whitebg" style="width: 337px">
                <div id="divTLCPercent" runat="server">
                    <asp:TextBox ID ="txtTLCPercent" runat ="server"> </asp:TextBox>               
                    <label>Percent</label>
                </div>
            </td> 
          </tr>
          <tr>
                <td class="form" style="width: 315px; height: 17px;">
                    <label class="right50 required">*Ordered by:</label> 
                    <asp:DropDownList ID="ddlOrderedbyName" runat="Server">
                        <asp:ListItem> Albert Hidoson</asp:ListItem>
                        <asp:ListItem> braham Lincon</asp:ListItem>
                    </asp:DropDownList>
                </td>
                <td class="form" style="width: 337px; height: 17px;"><label class="right50 required" for="OrderedDate">*Ordered by Date:</label> 
                    <input id="txtOrderedDate"  onblur="DateFormat(this,this.value,event,false,'3')" onkeyup="DateFormat(this,this.value,event,false,'3')" 
                        onfocus="javascript:vDateType='3'" maxlength="11" size="11" 
                            name="OrderedDate" runat="server"/> 
                        <img id="appDateimg1" onclick="w_displayDatePicker('<%=txtOrderedDate.ClientID%>');" height="22 "
                            alt="Date Helper" hspace="5" src="../images/cal_icon.gif" width="22" border="0" name="appDateimg"/>
                        <span class="smallerlabel" id="appDatespan1">(DD-MMM-YYYY)</span>
                </td>
          </tr>
     
          <tr>
            <td class="form" style="width: 315px; height: 22px;" >
                <label class="right50 required">*Reported by:</label> 
                <asp:DropDownList ID="ddlReportedBy" runat="server" >
                    <asp:ListItem> Albert Hidoson</asp:ListItem>
                    <asp:ListItem> braham Lincon</asp:ListItem>
                </asp:DropDownList>
            </td>
      
            <td class="form" style="width: 337px; height: 22px;">
                <label class="right50 required" for="ReportedbyDate">*Reported by Date:</label> 
                <input id="txtReportedDate" onblur="DateFormat(this,this.value,event,false,'3')" onkeyup="DateFormat(this,this.value,event,false,'3')"
                        onfocus="javascript:vDateType='3'" maxlength="11" size="11" name="ReportedDate" runat="server"/> 
                <img id="appDateimg2" onclick="w_displayDatePicker('<%=txtReportedDate.ClientID%>');" height="22" alt="Date Helper" hspace="5" src="../images/cal_icon.gif" 
                        width="22" border="0" name="appDateimg"/>
                        <span class="smallerlabel" id="appDatespan2">(DD-MMM-YYYY)</span> 
             </td>
           </tr>
           
           <tr>
        <td class="form" align="center" colspan="2" style="height: 16px">
            <asp:Button id="btnSubmit" Text="Submit" runat="server" OnClick="btnSubmit_Click"/>
            <asp:Button id="btnCancel" Text="Cancel" runat="server" OnClick="btnCancel_Click"/>
        </td>
        </tr>
        </tbody>
       </table>
    </div>
  </form>
  
</body>
</html>

